Description

Patient lifts are devices (hydraulic, mechanical, electric) that are designed to provide a means of transferring a person safely from one area to another and back when the individual is unable to assist with the transfer.

Criteria

Patient lifts may be considered medically necessary when the individual's condition is such that periodic movement is necessary to effect improvement or to arrest/retard deterioration in his condition.

Patient lifts may be considered medically necessary DME:

• If one of the following conditions is met; and
• If transfer between bed and a chair, wheelchair, or commode requires the assistance of more than 1 person and, without the use of a lift; the member would be bed-confined.

Medically necessary conditions:

• Advanced degenerative muscular diseases such as: muscular dystrophy
• Bilateral amputee
• Coma
• Contractures (rigidity)
• Degenerative joint disease
• Fracture pelvis or spine
• Hip spica or body cast
• Paralysis (hemiplegia, paraplegia, quadriplegia, hemiparesis)
• Rheumatoid arthritis
• Severe congestive heart failure
• Severe neurological disorders such as: multiple sclerosis, amyotrophic lateral sclerosis, syringomyelia, spinal cord tumors, advanced cerebellar degeneration
• Stroke (CVA or cerebral vascular accident)

When the individual's condition is other than one listed above, the claim should be referred for medical review to determine medical necessity for the lift.

Patient lifts not meeting the above criteria are considered non-covered.

Procedure Codes

The following types of patient lifts are not covered because they do not meet the definition of covered durable medical equipment (DME) or because they are considered home modifications or convenience items:

• Patient lifts used primarily to move an individual in or out of the bathtub; and
• Auto lifts ( used to lift a wheelchair into a car, truck or van); and
• Wheelchair lifts or ramps (e.g., Wheel-O-Vator lift) (provides access to stairways or car trunks); and
• Ceiling lifts (patient lifts mounted on tracks that are attached to the ceiling); and
• Platform lifts, stair lifts, and stairway elevators.

Procedure Codes

Diagnosis Codes

NA

Professional Statements and Societal Positions Guidelines

NA